The Patient’s Perspective on the Effects of Intranasal Esketamine in Treatment-Resistant Depression

• Published in: Brain sciences Vol. 13; no. 10; p. 1494
• Main Authors: Pepe, Maria, Bartolucci, Giovanni, Marcelli, Ilaria, Pesaresi, Francesco, Brugnami, Andrea, Caso, Romina, Fischetti, Alessia, Grisoni, Flavia, Mazza, Marianna, Camardese, Giovanni, Di Nicola, Marco, Sani, Gabriele
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.10.2023; MDPI
• Subjects: Antidepressants; Cognition; Cognition & reasoning; Depression, Mental; Drug therapy; glutamatergic system; Hedonic response; Mental depression; mood disorders; patient experience; Patients; personalized medicine; Phenotypes; Psychopathology; psychopharmacology; Respiratory agents; Suicide
• ISSN: 2076-3425; 2076-3425
• DOI: 10.3390/brainsci13101494

The effectiveness of the esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) has been confirmed by real-world studies. Available evidence derived from clinician-rated assessments might differ from patients’ perceptions about the helpfulness of treatments. We aimed to verify the effect of ESK-NS from patients’ view in 25 TRD patients (56% males, 55.1 ± 10.9 years) treated with ESK-NS (mean dose: 78.4 ± 11.43 mg) for three months and evaluated at different time-points through clinician-rated and self-administered scales, assessing changes in depression, anhedonia, sleep, cognition, suicidality, and anxiety. We observed an overall early improvement that lasted over time (endpoint total score reduction in Montgomery-Åsberg Depression Rating Scale, p < 0.001, Beck Depression Inventory, p = 0.003). Patients reported a significant self-rated decrease in anhedonia at two months (Snaith–Hamilton Pleasure Scale, p = 0.04) and in suicide ideation at endpoint (BDI subitem 9, p = 0.039) vs. earlier improvements detected by clinicians (one-month reduction in MADRS subitem 8, p = 0.005, and subitem 10, p = 0.007). These findings confirm the effectiveness of a three-month treatment with ESK-NS in TRD patients, highlighting an overall overlapping response from patients’ and clinicians’ perspectives, although with some differential effects on specific symptoms at given time-points. Including patients’ viewpoints in routine assessments could inform clinical practice, ensuring a better characterization of clinical phenotypes to deliver personalized interventions.